Lung cancer accounts for 27% of U.S. cancer deaths. The National Lung Screening Trial demonstrated that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality. The U.S. Preventive Services Task Force recommends offering annual LCS accompanied by smoking cessation treatment to high-risk, older individuals. Payers cover LDCT-LCS for high-risk individuals, and Medicare requires LDCT-LCS sites to offer smoking cessation to current smokers. Health care systems adopting LDCT- LCS have a critical new opportunity to deliver tobacco cessation treatment to smokers at a teachable moment. However, a comprehensive treatment strategy for these smokers undergoing LCS has not yet been determined, and there are challenges to integrating tobacco treatment services into high-volume radiology practices. This project will address this question in a large integrated health care delivery system by integrating into its LDCT-LCS sites a novel, personalized, evidence-based smoking cessation intervention in English and Spanish. To maximize the reach of tobacco treatment, smokers will be offered personalized assistance and outreach at 3 time points (LDCT-LCS test order, scan, and results). We will utilize novel health information technology (IT) platforms to promote patient outreach and access, using technologies like patient portals, informational videos (Vidscrip), and video-conferencing (MGH Telehealth). Guided by the Health Belief and Self Regulation models with a chronic disease management perspective, the multi-component LCS-tailored intervention targets the older, long-term, heavy smokers who will undergo LCS. It provides counseling support and pharmacotherapy (nicotine replacement therapy [NRT]); is personalized to smokers' risk perceptions, readiness to quit, and LCS results; and links smokers to a community resource database to address sociocultural barriers to cessation (Helpsteps). A centralized tobacco treatment specialist will deliver the intervention in a series of proactive motivational telephone- or videoconferencing-based sessions to sustain patient engagement. A randomized trial with a factorial design will test 3 intervention components that vary by (1) counseling duration, (2) NRT dose, and (3) provision of HelpSteps among 960 current smokers undergoing LDCT-LCS at 6 screening sites in Partners HealthCare System. The primary outcome is biochemically- validated 7-day point-prevalence tobacco abstinence rates at 6 months. Exploratory analyses will identify patient- and LCS-level factors that moderate the relationship between intervention group and smoking outcomes, including socio-demographic characteristics, medical and smoking characteristics, and LCS-related factors (i.e., LCS result, time point of study entry). Guided by the RE-AIM framework, we will evaluate the intervention's reach, adoption, and implementation, including cost-effectiveness. The proposal tests an innovative model that could provide LDCT-LCS sites and health care systems with an evidence-based way to build on the teachable moment afforded by LCS and thereby help reduce tobacco-related disease burden.